| NPI | 1538683537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO3173) |
| Additional Taxonomies | 224P00000X Prosthetist |
| 222Z00000X Orthotist (Licence: CPO3173) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2020-02-12 |